Healthcare Provider Details

I. General information

NPI: 1003618828
Provider Name (Legal Business Name): LILANA SUKKARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 S STATE ST
ANN ARBOR MI
48104-6184
US

IV. Provider business mailing address

2245 S STATE ST
ANN ARBOR MI
48104-6184
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-0209
  • Fax: 734-769-0224
Mailing address:
  • Phone: 734-769-0209
  • Fax: 734-769-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number135356154
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: